With Omicron now in Connecticut and at least a third of the United States, what are the best treatments against this new COVID-19 variant with an unprecedented number of mutations and when will they be available?
Here’s a look at three primary treatments:
Antiviral Pills
Oral antivirals from Pfizer (Paxlovid) and Merck (Molnupiravir) could become a vital transitional treatment for mild to moderate COVID-related illness while vaccines and other frontline treatments are reformulated for Omicron.
These pills are protease inhibitors that block an enzyme required by the virus to replicate, using a technology that should not be affected by the high number of Omicron’s spike-protein mutations.
Both are expected to authorized soon by the Food and Drug Administration.
“As the companies ramp up production,” says Eric Arlia, Hartford HealthCare’s Senior Director of Pharmacy, “there probably will be a limited supply at first, so the state will be working with providers to decide the best way to distribute it in the early weeks.”
An FDA expert advisory committee voted recently to recommend Merck’s Molnupiravir (shown above) for Emergency Use Authorization for high-risk adults. Merck earlier reported the drug reduced risk of hospitalization and death by 30 percent, down from 50 percent in previous testing.
Pfizer said Paxlovid reduced hospitalization and death by 89 percent when taken with the common HIV drug Ritonavir within three days of initial symptoms. The drugmaker expects to produce 80 million treatments by the end of next year, an increase from previous plans of 50 million. The federal government already has ordered 10 million courses. The FDA is also reviewing Paxlovid.
“The couple of pills that are going to be coming out, possibly, could be game-changers,” says Dr. Ulysses Wu, Hartford HealthCare’s System Director of Infection Disease and Chief Epidemiologist.
Vaccines
It’s back to the laboratory for vaccine makers after Omicron’s arrival. It could take months before Pfizer-BioNTech and Moderna reformulate and distribute their mRNA vaccines to fight this new, more transmissible strain.
But lab study results released Dec. 8 by Pfizer and BioNTech say three doses of their vaccine produce a similar level of neutralizing antibodies to Omicron as two doses produced against the original virus and subsequent variants.
Current vaccines also might protect against severe illness. Omicron could evade vaccine-generated antibodies, but it could still be vulnerable to immune cells that attack the virus, says BioNTech SE co-founder Ugur Sahin.
Managing a COVID-related illness could become as important as preventing it.
“We have more tools in our toolbox to manage patients,” says Dr. Ajay Kumar, Hartford HealthCare’s Chief Clinical Officer. “We are better prepared as a system, as a hospital. We have stringent safety measures in our acute and other facilities at this time. So we feel very comfortable and confident to manage where we are right now and whatever is to come.”
Antibody Drugs
Monoclonal antibodies, a drug cocktail delivered through an intravenous infusion, lose effectiveness against Omicron, according to early test results from Regeneron Pharmaceuticals. Like the vaccines, this treatment also might need modification. The drugs use molecules made in the laboratory from COVID survivors or mice engineered to have human-like immune systems. When administered soon after an infection, the drugs attach to the virus and prevent it from infecting more cells. Vaccines, meanwhile, essentially educate the immune system to fight the virus.
Both Regneron’s and Lily’s drugs target the spike protein. Omicron, with 30 spike protein mutations, will challenge this technology.
If further testing confirms the antibody treatment is less effective against Omicron, Regeneron says it will move to alternative antibodies already developed. One is now in clinical testing.
Monoclonal antibodies will remain a valuable treatment against Delta, still the world’s dominant COVID-19 strain. It reduces the risk of severe COVID-19 by up to 85 percent.
“For the most part,” says Dr. Wu, “we have been giving monoclonals to a large majority of people who have been either asymptomatic or had mild symptoms of COVID. If anybody has been diagnosed with COVID and doesn’t meet the requirement for hospitalization, we certainly can treat you with monoclonals.
This story was updated Dec. 8, 2021.